The Dark Side of Linus Pauling's Legacy

Stephen Barrett, M.D.

Linus Pauling, Ph.D. (1901-1994), was the
only person ever to win two unshared Nobel prizes. He received
these awards for chemistry in 1954 and for peace in 1962. He contributed greatly to the development of chemical theories.
His impact on the health marketplace, however, was anything but
laudable.

Pauling is largely responsible for the widespread
misbelief that high doses of vitamin C are effective against colds
and other illnesses. In 1968, he postulated that people's needs
for vitamins and other nutrients vary markedly and that to maintain
good health, many people need amounts of nutrients much greater
than the Recommended Dietary Allowances (RDAs). And he speculated
that megadoses of certain vitamins and minerals might well be
the treatment of choice for some forms of mental illness. He termed
this approach "orthomolecular," meaning "right
molecule." After that, he steadily expanded the list of illnesses
he believed could be influenced by "orthomolecular"
therapy and the number of nutrients suitable for such use. No
responsible medical or nutrition scientists share these views.

Vitamin C and the Common Cold

In 1970, Pauling announced in Vitamin
C and the Common Cold that taking 1,000 mg of vitamin C daily
will reduce the incidence of colds by 45% for most people but
that some people need much larger amounts [1]. (The RDA for vitamin
C is 60 mg.) The 1976 revision of the book, retitled Vitamin
C, the Common Cold and the Flu, suggested even higher dosages
[2]. A third book, Vitamin C and Cancer (1979) claims that
high doses of vitamin C may be effective against cancer. Yet another
book, How to Feel Better and LiveLonger (1986),
stated that megadoses of vitamins "can improve your general
health . . . to increase your enjoyment of life and can help in
controlling heart disease, cancer, and other diseases and in slowing
down the process of aging." [3] Pauling himself reportedly
took at least 12,000 mg daily and raised the amount to 40,000
mg if symptoms of a cold appear [4]. In 1993, after undergoing
radiation therapy for prostate cancer, Pauling said that vitamin
C had delayed the cancer's onset for twenty years. This was not
a testable claim. He died of the disease in August 1994.

Scientific fact is established when the
same experiment is carried out over and over again with the same
results. To test the effect of vitamin C on colds, it is necessary
to compare groups which get the vitamin to similar groups which
get a placebo (a dummy pill which looks like the real thing).
Since the common cold is a very variable illness, proper tests
must involve hundreds of people for significantly long periods
of time. At least 16 well-designed, double-blind
studies have shown that supplementation with vitamin C does not
prevent colds and at best may slightly reduce the symptoms of
a cold [5]. Slight symptom reduction may occur as the result
of an antihistamine-like effect, but whether this has practical
value is a matter of dispute. Pauling's views are based on the
same studies considered by other scientists, but his analyses
are flawed.

The largest clinical trials, involving thousands
of volunteers, were directed by Dr. Terence Anderson, professor
of epidemiology at the University of Toronto [6-9]. Taken together,
his studies suggest that extra vitamin C may slightly reduce the
severity of colds, but it is not necessary to take the high doses
suggested by Pauling to achieve this result. Nor is there anything
to be gained by taking vitamin C supplements year-round in the
hope of preventing colds.

Another important study was reported in
1975 by scientists at the National Institutes of Health who compared
vitamin C pills with a placebo before and during colds. Although
the experiment was supposed to be double-blind, half the subjects
were able to guess which pill they were getting. When the results
were tabulated with all subjects lumped together, the vitamin
group reported fewer colds per person over a nine-month period.
But among the half who hadn't guessed which pill they had been
taking, no difference in the incidence or severity was found [10].
This illustrates how people who think they are doing something
effective (such as taking a vitamin) can report a favorable result
even when none exists.

Vitamin C and Cancer

In 1976, Pauling and Dr. Ewan Cameron, a
Scottish physician, reported that a majority of one hundred "terminal"
cancer patients treated with 10,000 mg of vitamin C daily survived
three to four times longer than similar patients who did not receive
vitamin C supplements [11,12]. However, Dr. William DeWys, chief
of clinical investigations at the National Cancer Institute, found
that the study was poorly designed because the patient groups
were not comparable [13]. The vitamin C patients were Cameron's,
while the other patients were under the care of other physicians.
Cameron's patients were started on vitamin C when he labeled them
"untreatable" by other methods, and their subsequent
survival was compared to the survival of the "control"
patients after they were labeled untreatable by their doctors.
DeWys reasoned that if the two groups were comparable, the lengths
of time from entry into the hospital to being labeled untreatable
should be equivalent in both groups. However, he found that Cameron's
patients were labeled untreatable much earlier in the course of
their disease—which means that they entered the hospital before
they were as sick as the other doctors' patients and would naturally
be expected to live longer.

Nevertheless, to test whether Pauling might
be correct, the Mayo Clinic conducted three double-blind studies
involving a total of 367 patients with advanced cancer. The
studies, reported in 1979, 1983, and 1985, found that patients
given 10,000 mg of vitamin C daily did no better than those given
a placebo [14-16]. Pauling criticized the first study, claiming
that chemotherapeutic agents might have suppressed the patients'
immune systems so that vitamin C couldn't work [17]. But his 1976
report on Cameron's work stated clearly that: "All patients
are treated initially in a perfectly conventional way, by operation,
use of radiotherapy, and the administration of hormones and cytotoxic
substances." And during a subsequent talk at the University
of Arizona, he stated that vitamin C therapy could be used along
with all conventional modalities [18]. The participants in the
1983 study had not undergone conventional treatment, but Pauling
dismissed its results anyway.

Science aside, it is clear that Pauling
was politically aligned with the promoters of unscientific nutrition
practices. He said his initial interest in vitamin C was aroused
by a letter from biochemist Irwin Stone, with whom he subsequently
maintained a close working relationship. Although Stone was often
referred to as "Dr. Stone," his only credentials were
a certificate showing completion of a two-year chemistry program,
an honorary chiropractic degree from the Los Angeles College of
Chiropractic, and a "Ph.D." from Donsbach
University, a nonaccredited correspondence school.

In a little-publicized chapter in Vitamin
C and the Common Cold, Pauling attacked the health-food industry
for misleading its customers. Pointing out that "synthetic"
vitamin C is identical with "natural" vitamin C, he
warned that higher-priced "natural" products are a "waste
of money." And he added that "the words 'organically
grown' are essentially meaningless—just part of the jargon
used by health-food promoters in making their excess profits,
often from elderly people with low incomes." But Vitamin
C, the Common Cold and the Flu, issued six years later, contained
none of these criticisms. This omission was not accidental. In
response to a letter, Pauling informed me that, after his first
book came out, he was "strongly attacked by people who were
also attacking the health-food people." His critics were
so "biased," he decided, that he would no longer help
them attack the health-food industry while another part of their
attack was directed at him [19].

The Linus Pauling Institute of Science and Medicine was founded in 1973 and operated under that name until 1995 [20]. The institute was dedicated to "orthomolecular medicine."
For many years, its largest corporate donor was Hoffmann-La Roche,
the pharmaceutical giant that produces most of the world's vitamin
C. Many of the institute's fundraising brochures contained
questionable information. During the 1980s, for example, they falsely stated
that no significant progress had been made in cancer treatment
during the previous twenty years.

A dispute between Pauling and Arthur Robinson,
Ph.D., gives additional evidence of Pauling's defense of vitamin
C megadosage was less than honest. Robinson, a former student
and long-time associate of Pauling, helped found the institute
and became its first president. According to an investigative
report by James Lowell, Ph.D., in Nutrition Forum newsletter,
Robinson's own research led him to conclude in 1978 that the high
doses (5-10 grams per day) of vitamin C being recommended by Pauling
might actually promote some types of cancer in mice [18]. Robinson
told Lowell, for example, that animals fed quantities equivalent
to Pauling's recommendations contracted skin cancer almost twice
as frequently as the control group and that only doses of vitamin
C that were nearly lethal had any protective effect. Shortly after
reporting this to Pauling, Robinson was asked to resign from the
institute, his experimental animals were killed, his scientific
data were impounded, and some of the previous research results
were destroyed. Pauling also declared publicly that Robinson's
research was "amateurish" and inadequate. Robinson responded
by suing the Institute and its trustees. In 1983, the suit was
settled out of court for $575,000. In an interview quoted in Nature,
Pauling said that the settlement "represented no more than
compensation for loss of office and the cost of Robinson's legal
fees." However, the court-approved agreement stated that
$425,000 of the settlement was for slander and libel. The Institute's own legal fees were close to a million dollars [21].

In 1994, Robinson and two colleagues summarized
the results of four mouse studies he had carried out while working
at the Pauling Institute [22]. Nearly all of the mice developed
skin cancers (squamous cell carcinomas) following exposure to
ultraviolet radiation. Altogether, 1,846 hairless mice received
a total of 38 different diets. The researchers found that (a) the rate of onset and severity of tumors could be varied
as much as 20-fold by just modifying dietary balance; (b) diets
with the worst balance of nutrients had the greatest inhibitory
effect on cancer growth; and (c) no cures or remissions were observed
(although the researchers were not looking for this). In 1999,
Robinson commented:

The results of these experiments caused an argument between
Linus and me, which ended our 16-year period of work together.
He was not willing to accept the experimentally proved fact that
vitamin C in ordinary doses accelerated the growth rate of squamous
cell carcinoma in these mice.

At the time, Linus was promoting his claim that "75%
of all cancer can be prevented and cured by vitamin C alone."
This claim proved to be without experimental foundation and not
true. . . . Vitamin C increased the rate of growth of cancer
at human equivalents of 1 to 5 grams per day, but suppressed
the cancer growth rate at doses on the order of 100 grams per
day (near the lethal dose), as do other measures of malnutrition
[23].

Recent laboratory studies have found that vitamin C may interfere with the effectiveness of five anti-cancer drugs. First, the researchers gave a vitamin C product to cancer cells that were treated with chemotherapy and found that the 30% to 70% fewer cancer cells were killed. Then they injected mice with cancer cells, administered chemotherapy, and found that cells grew into tumors much faster in the mice that received pre-treatment vitamin C. The researchers warned that although results in animals are not necessarily applicable to humans, vitamin C supplementation during cancer treatment may interfere with the effect of chemotherapy in humans [24].

Other Questionable Activities

During the mid-1970s, Pauling helped lead
the health-food industry's campaign for a federal law that weakened
FDA protection of consumers against misleading nutrition claims.
In 1977 and 1979, Pauling received awards and presented his views
on vitamin C at the annual conventions of the National Nutritional
Foods Association (the major trade association of health-food
retailers, distributors and producers). In 1981, he accepted an
award from the National Health Federation (NHF) for "services
rendered in behalf of health freedom" and gave his daughter
a life membership in this organization. NHF promotes the gamut
of quackery. Many of its leaders have been in legal difficulty
and some have even received prison sentences for various "health"
activities. Pauling also spoke at a Parker School for Professional
Success Seminar, a meeting where chiropractors were taught highly
questionable methods of building their practices. An ad for the
meeting invited chiropractors to pose with Pauling for a photograph
(which presumably could be used for publicity when the chiropractors
returned home).

In 1981, after learning that Pauling had
donated money to NHF (for his daughter's life membership), I asked
whether he knew about NHF's shady background and the fact that
it was the leading antifluoridation force in the United States.
I also asked whether he cared that the money might be used to
help fight fluoridation. In a series of letters, he replied that
he: (a) strongly supported fluoridation, (b) was aware of NHF's
opposition, (c) had tried to pressure the organization to change
its views, (d) had spoken out for it often and over many years,
and (e) thought other issues were more important [19]. He also
sent me a profluoridation
statement he had issued in 1967 [25]. His claim that he had
spoken out for fluoridation surprised me. Although I have read
thousands of documents related to Pauling's views and activities,
I had never encountred any other indication that he had publicly supported fluoridation.

In 1983, Pauling and
Irwin Stone testified at a hearing on behalf of Oscar Falconi,
a vitamin promoter charged by the Postal Service with making false
claims for several products. Pauling supported Falconi's contentions
that vitamin C was useful not only in preventing cancer, but also
in curing drug addicts and destroying both viruses and bacteria.
The Administrative Law Judge concluded that Pauling could not substantiate his claims [26].

Pauling also testified in 1984 before the California Board of
Medical Quality Assurance in defense of Michael Gerber, M.D.,
who was accused of improperly administering to patients. One was
a 56-year-old woman with treatable cancer who—the Board concluded—had died as a result of Gerber's neglect while he treated her
with herbs, enzymes, coffee enemas, and chelation therapy. The
other patients were three-year-old twin boys with ear infections
for which Gerber had prescribed 70,000 or more units of vitamin
A daily and coffee enemas twice daily for several weeks. The Board found Gerber guilty of gross negligence and incompetence,
repeated similar negligent acts, and other similar charges and revoked his California medical license. He now practices in Nevada under
a homeopathic license.

A flyer distributed in 1991 by the Linus
Pauling Institute recommended daily doses of 6,000 to 18,000 mg
of vitamin C, 400 to 1,600 IU of vitamin E, and 25,000 IU of vitamin
A, plus various other vitamins and minerals. These dosages have
no proven benefit and can cause troublesome side effects. In the Gerber case, Pauling testifoed that the proper intake of vitamin C for adults was"around 10 or 20 grams per day," that this would significantly reduce death rates, and that he knew of people who had taken 150 grams of vitamin C daily for years without serious side effects [27].

Today's Linus Pauling Institute

After Pauling died, fundraising appeals expressed concern that his death would make it more difficult to raise funds to continue the institute's operations. In 1996, the assets of the Linus Pauling Institute of Science and Medicine were used to establish the Linus Pauling Institute (LPI) as a research institute at OSU to investigate the function and role of micronutrients, phytochemicals and microconstituents of food in maintaining human health and preventing and treating disease; and to advance the knowledge in areas which were of interest to Linus Pauling through research and education [28].

The LPI Web site has excellent articles about the function and role of many nutrients. Except for vitamin E, the LPI's recommended nutrient levels are in line with prevailing scientific opinions. One article notes that Pauling's vitamin C recommendations were based on "theoretical arguments" and that we now have much more scientific information upon which to base recommendations [29]. This certainly is true but glosses over the fact that Pauling's meganutrient theories were absurd and were maintained even after scientific studies refuted them. Overall, however, the LPI is now a respectable education and research facility.

The Bottom Line

Although Pauling's megavitamin claims lacked
the evidence needed for acceptance by the scientific community,
they have been accepted by large numbers of people who lack the
scientific expertise to evaluate them. Thanks largely to Pauling's
prestige, annual vitamin C sales in the United States have been
in the hundreds of millions of dollars for many years. Pauling also played a role in the health food industry's successful campaign to weaken FDA consumer protections laws. The Linus Pauling Institute that bears his name has evolved into a respectable organization. But Pauling's irrational advice about supplements continues to lead people astray.

Cameron E, Pauling L. Supplemental ascorbate in the supportive
treatment of cancer: reevaluation of prolongation of survival
times in terminal human cancer. Proceeding of the National Academy
of Sciences 75:4538-4542, 1978.

DeWys WD. How to evaluate a new treatment for cancer. Your
Patient and Cancer 2(5):31-36, 1982.